ORAL ANTICOAGULATION - IMPROVING THE RISK-BENEFIT RATIO

For four decades, warfarin has been used extensively to treat thromboe mbolic disorders. Major advances in monitoring have been achieved thro ugh recognition of thromboplastin variability and implementation of th e international normalized ratio (INR). Recommended INR ranges have sh ifted to lower intensity, and new clinical information has led to the potential for increased use of warfarin to prevent venous thromboembol ism, to treat patients with prosthetic heart valves, to prevent stroke in patients with atrial fibrillation, and to prevent death and recurr ent events after myocardial infarction. Optimal management of the pati ent who requires a drug that has a narrow therapeutic index, such as w arfarin, remains challenging. Strategies to enhance patient outcomes w ith these drugs attempt to improve the risk-benefit ratio of such ther apies, which requires optimizing the agent's effectiveness, improving its, safety profile, or both.